Significant left hemothorax after transapical closure of cardiac apex with minithoracotomy and transapical transcatheter prosthetic mitral paravalvular leak closure

Abstract

The transapical transcatheter approach for mitral valve interventions is generally performed in patients when transseptal attempt failed in case of high surgery risk. The apical access is traditionally performed through a left minithoracotomy at the fifth intercostal space under general anesthesia. But, some complications may be occurred during apical access even though it is a minimally invasive procedure [ 1 Blumenstein J. Kempfert J. Kim W. Liebetrau C. Möllmann H. Walther T. Transapical access and closure devices: rationale and current status. Expert. Rev. Cardiovasc. Ther. Dec 2013; 11: 1613-1617 Crossref PubMed Scopus (8) Google Scholar , 2 Tang L. Fang Z. Hu X. Tang J. Shen X. Lu X. Zhao Y. Li J. Zhou S. Non-surgical repair of ventricular septal rupture after acute myocardial infarction. Int. J. Cardiol. Mar 17 2015; : 328-332 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 3 Dardas P.S. Kelpis T.G. Ninios V.N. Mezilis N.E. Tsikaderis D.D. Pitsis A.A. Thanopoulos V.D. Successful transapical transcatheter prosthetic mitral paravalvular leak closure. Hell. J. Cardiol. Nov–Dec 2014; 55 (No abstract available): 510-511 PubMed Google Scholar , 4 Yanartaş M. Demir S. Baysal A. Fedakar A. Alizade E. Sahin M. Taş S. Sunar H. The relation between location of paravalvular leakage and time to reoperation after mitral valve replacement. Anadolu Kardiyol. Derg. 2014 Feb; 14: 61-67 Crossref PubMed Scopus (5) Google Scholar , 5 Uzun M. The value of real-time three-dimensional transesophageal echocardiography in the assessment of paravalvular leak origin following prosthetic mitral valve replacement: real-time three-dimensional echocardiography and cardiology. Turk Kardiyol. Dern. Ars. 2009 Dec; 37 (No abstract available): 595-596 PubMed Google Scholar , 6 Yildiz M. Duran N.E. Gökdeniz T. Kaya H. Ozkan M. The value of real-time three-dimensional transesophageal echocardiography in the assessment of paravalvular leak origin following prosthetic mitral valve replacement. Turk Kardiyol. Dern. Ars. 2009 Sep; 37: 371-377 PubMed Google Scholar ]. These are ventricular arrhythmias, ventricular tear and life-threatening surgical bleeding. In addition to these complications, left hemothorax may be occurred as in our case [ 7 Rashid M.A. Successful emergency resuscitative thoracotomy and thoracoscopy in an injured patient with impending death. Eur. J. Cardiothorac. Surg. 2008 Jun; 33: 1153-1154 Crossref PubMed Scopus (1) Google Scholar , 8 Ota H. Kawai H. Matsuo T. Video-assisted minithoracotomy for blunt diaphragmatic rupture presenting as a delayed hemothorax. Ann. Thorac. Cardiovasc. Surg. 2014; 20: 911-914 Crossref PubMed Scopus (8) Google Scholar , 9 Fernando Rajeev Briceno David F. Loyalka Pranav Kar Biswajit Transapical closure of mitral paravalvular leak over a surgically constructed mitral annulus. Int. J. Cardiol. 2014; 171: 302-304 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ]. Now, new apical closure devices have been developed and used for the apical closure [ 10 Ferrari E. Locca D. Berdajs D. Marcucci C. Gronchi F. Lavanchy J. Prêtre R. Tozzi P. Use of a ventricular septal defect occluder for apical closure in transapical aortic valve replacement. Innovations (Phila). Jan–Feb 2015; 10: 68-70 Crossref PubMed Scopus (8) Google Scholar , 11 Blumenstein J. Kempfert J. Van Linden A. et al. First-in-man evaluation of the transapical APICA ASCi access and closure device: the initial 10 patients. Eur. J. Cardiothorac. Surg. 2013; 44: 1057-1062 Crossref PubMed Scopus (26) Google Scholar , 12 Brinks H. Nietlispach F. Göber V. Englberger L. Wenaweser P. Meier B. Carrel T. Huber C. Transapical access closure: the TA PLUG device. Interact. Cardiovasc. Thorac. Surg. Nov 2013; 17: 806-809 Crossref PubMed Scopus (12) Google Scholar ] and the cardiologists started to use the occluders to close the percutaneous apical accesses without left minithoracotomy. If the patient is overweight, the percutaneous apical puncture may not be available. On the other hand, the left minithoracotomy is very easy for cardiologists, so a cardiovascular surgeon does everything and says ‘everything is ready for apical puncture’. Herein, we report a case of a successful closure of the transapical mitral paravalvular leak with minithoracotomy complicated left significant hemothorax. Recently, we reported two cases of percutaneous apical closure of cardiac apex [ 13 Ozturk C. Iyisoy A. Celik T. Balta S. Bozlar U. Demir M. Yildirim A.O. Guler A. Computed tomography guided percutaneous transapical closure of cardiac apex after prosthetic mitral paravalvular leak closure. Int. J. Cardiol. 2015; : 37-39 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar , 14 Iyisoy A. Ozturk C. Celik T. Demirkol S. Cingoz F. Unlu M. Arslan Z. Percutaneous transapical closure of cardiac apex with an ADO-II device after successful transapical transcatheter prosthetic mitral paravalvular leak closure. Int. J. Cardiol. Jun 15 2015; 189: 289-292 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ]. One was fluoroscopic and another one was computed tomography guided apical approach.